Continuous Intra-Incisional Bupivacaine for Postoperative Analgesia after Hip Nailing Surgery: A Randomized Clinical Trial.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2024;12(24):9 Pain Res Manag . 2024 Jul 22:2024:2357709.What this means for my practice?
Continuous intra-incisional infusion of bupivacaine significantly reduces postoperative pain, delays opioid use, and minimizes opioid-related side effects in patients undergoing hip nailing surgery. This approach improves patient satisfaction and may enhance recovery. The study’s findings may be influenced by challenges in catheter placement and limited blinding due to the lack of a sham catheter in the control group.
Study Summary
Forty-eight patients with intertrochanteric fractures were randomized to receive either continuous intra-incisional bupivacaine infusion (n=24) or no infusion (n=24) following hip nailing surgery. The primary outcome was postoperative pain intensity, measured by the Numerical Rating Scale (NRS). Secondary outcomes included opioid consumption, time to first morphine request, drug-related complications, and patient satisfaction within 24 hours postoperatively. Overall, the study found that patients receiving bupivacaine had significantly lower pain scores, reduced morphine consumption (p<0.001), delayed first morphine request (p<0.001), and fewer complications like nausea and vomiting (p=0.02). These findings suggest that continuous intra-incisional bupivacaine is effective in managing postoperative pain while minimizing opioid use and associated side effects.
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